Coping with the Emotional Side Effects of Treatment

After Prostate Cancer

by Joel D. Marcus, PSYD

Prostate cancer continues to be one of the most common types of cancer in American men. Pros­tate cancer can be diagnosed at any age, but it is generally diagnosed in men over 50. Men of this age group are generally married or have a long-term partner. Consequently, the emotional impact of a prostate cancer diagnosis will affect not only the man, but his partner as well.

Fortunately, treatment advances are resulting in a longer expected survival for most men. After treatment, men are likely to be satisfied if they are free from the disease, there were no complications, and they have good overall health. Quality of life is­sues should be a major concern in evaluating the dif­ferent treatment options. Long-term goals naturally fo­cus on maximizing survival, but in the short term, cancer survivors wish to know how treatment will affect their quality of life. How­ever, there are few studies about psychological adjustment to prostate cancer and its treatment.

Side Effects of Prostate Cancer Treatment
Unfortunately, urinary and sexual dysfunctions are common after prostate cancer treatment. Complaints are highest among men who have had prostatectomy and lowest among men who selected active surveillance. These symptoms can have a significant impact on men’s lives.

Regardless of the choice of treatment for prostate cancer, there is a risk for sexual dysfunction. The majority of prostate cancer survivors report relatively positive adjustment in most areas of life, except sexual functioning. Inter­estingly, prostate cancer survivors with erectile dysfunction appear to have better disease-specific quality of life than men with erectile dysfunction who have not had prostate cancer.

The emotional impact of a prostate cancer
diagnosis will affect not only the man, but
his partner as well.

Dr. Joel Marcus

It is critical that clinicians assist sur­vivors in dealing with the psychosocial impact of prostate cancer.

Psychological Treatments
Psycho­logical interventions fall into three basic domains: interpersonal psychotherapy, psycho-education, and cognitive behav­ioral therapy. No particular therapy is designed to stand alone, and aspects of each therapeutic entity can and should be integrated into the treatment plan as the man and his partner’s needs dictate.

Interpersonal therapy is employed to help the individual and the couple adequately deal with the change in func­tional status. Emotion-focused coping to manage sexual issues appears to re­sult in poor psychological adjustment.

Psycho-education is used to educate the survivor about his personal response to the disease and treatment and to help him comprehend the impact of this threat and to respond to it. Psycho-educational interventions tend to be the most ef­fective in the first four months after treatment, when the treatment effects are at their greatest.

Cognitive behavioral therapy is an evidence-based therapy that is effective in helping people make emotional and behavioral changes. Once the link
between emotions and behavior is ac­knowledged, the opportunity exists to develop and implement new behaviors and coping strategies. CBT is often effectively integrated within the first two categories of psychological inter­ventions mentioned.

Issues of incontinence and erectile dysfunction may be present in the
majority of men receiving standard treatment for prostate cancer. This re­quires the survivor and his partner to address issues of sexuality and intimacy. The impact of the diagnosis and treat­ment can be profound and debilitating, or it can be minimal on the survivor and his loved ones.

The change of the survivor’s psycho­sexual status can affect his partner, who may not want to initiate sexual activity because of a fear of failure. This, in turn, can decrease communication and diminish sexual intimacy. This vicious cycle can repeat itself and worsen an already shaky psychosexual situation.

Men and women think and respond differently to intimacy and relationship challenges that occur because of pros­tate cancer diagnosis and treatment. The relationship and intimacy needs that are unique to men, women, and couples all need to be assessed and treated.

This may be the first time that such issues have arisen for the couple. But to be fully effective, interventions for survivors of prostate cancer must involve both the survivor and his partner.

The first step is sometimes the hardest – talking about it.

♦ ♦ ♦ ♦ ♦

Dr. Joel Marcus is a
psychologist whose focus is on psychosocial oncology.

This article was published in Coping® with Cancer magazine,
May/June
2011.